Hiatus Hernia: What It Is, Symptoms, Treatment & Surgery

 

Introduction

In the vast realm of medical conditions, hiatus hernia stands as a relatively common yet sometimes misunderstood ailment. While its name might not immediately evoke recognition, understanding hiatus hernia is paramount for anyone seeking to navigate its symptoms, treatment options, and potential surgical interventions. This comprehensive article aims to shed light on hiatus hernia—what it is, its various types, prevalent symptoms, risk factors, treatment approaches and surgical options, and address frequently asked questions.

About Hiatus Hernia

Hiatus hernia, often referred to as hiatal hernia, is a condition in which a portion of the stomach pushes through the diaphragm and protrudes into the chest cavity. The diaphragm, a crucial muscle responsible for breathing, normally separates the chest and abdominal cavities. A hiatus hernia disrupts this separation, leading to discomfort and possible complications.

Types of Hiatus Hernia

Two primary types of hiatus hernia exist:

• Sliding Hiatus Hernia: This is the most prevalent type, wherein a portion of the stomach and the junction between the esophagus and stomach (gastroesophageal junction) slide up into the chest through the hiatal opening. This can lead to gastroesophageal reflux disease (GERD) due to the weakened barrier between the stomach and the esophagus.

• Paraesophageal Hiatus Hernia: Less common but potentially more serious, paraesophageal hernias involve a part of the stomach protruding alongside the esophagus without necessarily affecting the gastroesophageal junction. This can lead to complications like strangulation, where the blood supply to the herniated portion is compromised, causing tissue damage.

Most Common Hiatus Hernias

Sliding hiatus hernias account for approximately 95% of cases. They are more common in individuals over 50 years of age and are often associated with GERD. On the other hand, paraesophageal hiatus hernias, though rare, carry a greater risk of complications due to the possibility of strangulation.

Symptoms of Hiatus Hernia

The symptoms of hiatus hernia can vary widely, ranging from mild discomfort to more pronounced issues:

• Heartburn: This is a common symptom, often felt as a burning sensation in the chest due to stomach acid flowing back into the esophagus.
  
  

• Regurgitation: It is the backflow of stomach contents (i.e. food) into the throat or mouth.
  
  

• Chest Pain: Some individuals might experience chest pain, which can mimic heart-related issues.
  
  

• Difficulty Swallowing: The herniated portion of the stomach can partially obstruct the esophagus, leading to difficulty in swallowing.
  
  

• Feeling Full: Early satiety or feeling full after consuming only a small amount of food.
  
  

• Respiratory Issues: In some cases, hiatus hernia can cause respiratory symptoms like coughing, wheezing, or shortness of breath.

Who is at most Risk from Hiatus Hernia?

While hiatus hernia can affect anyone, certain factors increase the risk:

• Age: The likelihood of a hiatus hernia increases with age as the muscles supporting the hiatus weaken over time.
  
  

• Obesity: Excess weight places additional pressure on the abdomen, contributing to hernia development.
  
  

• Pregnancy: The growing uterus can push against the stomach, potentially causing a hiatus hernia.
  
  

• Smoking: Smoking weakens the muscles and increases the risk of herniation.
  
  

• Lifestyle Factors: Factors like poor diet and lack of physical activity can contribute to hiatus hernia risk.

How Hiatus Hernia is treated?

Most hiatal hernias do not require treatment. However, if you have symptoms, such as heartburn or acid reflux, your doctor may recommend one of the following treatments:

• Medication: There are a number of medications that can help to control heartburn and acid reflux. These medications include proton pump inhibitors (PPIs), H2 blockers, and antacids.
  
  

• Lifestyle changes: There are a number of lifestyle changes that can help to relieve the symptoms of hiatal hernia, such as:
  
  

• Losing weight

• Quitting smoking

• Avoiding foods and drinks that trigger heartburn (e.g. spicy foods, caffeine, alcohol)

• Elevating the Head: Sleeping with the head elevated can help prevent nighttime reflux.
  
  

• Surgery: In severe cases or when other treatments fail, surgery might be considered to repair the hernia and prevent reflux.

Hiatus Hernia Surgery:

Surgical intervention is usually reserved for cases where symptoms are severe, complications arise, or conservative treatments are ineffective. The most common surgical procedure is called Nissen fundoplication, where the top part of the stomach is wrapped around the lower esophagus to reinforce the barrier against reflux. This surgery can often be performed laparoscopically, minimizing recovery time.

FAQs:

Q1: What are the symptoms of hiatal hernia?

A: The most common symptoms of hiatal hernia are:

• Heartburn

• Acid reflux

• Indigestion

• Burping

• Regurgitation

• Chest pain

• Difficulty swallowing

• Nausea

• Vomiting

Q2: How is a hiatal hernia diagnosed?

A: Your doctor can diagnose a hiatal hernia by performing a physical examination and asking about your symptoms. As per the requirements, the doctors can also order the following tests:

• Upper GI endoscopy: In this test, a thin, flexible tube with a camera is inserted into your esophagus and stomach. This allows your doctor to see if there is a hiatal hernia and to rule out other conditions.
  
  

• Barium swallow: In this test, you are allowed to drink a liquid which contains barium. The barium coats the inside of your oesophagus and stomach, making it easier to see on X-rays.

• pH Manometry

Q3: Can hiatus hernia lead to cancer?
A: No, hiatus hernia itself does not cause cancer, but it can increase the risk of GERD, which is a risk factor for Barrett's esophagus and esophageal cancer.

Q4: Can hiatal hernia be prevented?

A: While it might not be entirely preventable, maintaining a healthy lifestyle, avoiding triggers, and managing weight can reduce the risk.

Q5: Is surgery the only option?
A: No, surgery is typically considered after other treatments fail to provide relief.

Conclusion

Hiatus hernia, though not always widely recognized, is a condition that can significantly impact an individual's quality of life. Understanding its types, symptoms, risk factors, and available treatments is vital for effective management. With appropriate lifestyle changes, medications, and, in some cases, surgical interventions, individuals diagnosed with hiatus hernia can find relief and regain control over their well-being. If you suspect you might be suffering from a hiatus hernia, seeking medical advice is crucial for accurate diagnosis and tailored treatment.